Identifying, Characterizing, and Classifying Congenital Anomalies of the Coronary Arteries

Abstract

The clinical manifestations of coronary artery anomalies vary in severity, with some anomalies causing severe symptoms and cardiovascular sequelae and others being benign. Cardiovascular computed tomography (CT) has emerged as the standard of reference for identification and characterization of coronary artery anomalies. Therefore, it is important for the reader of cardiovascular CT images to be thoroughly familiar with the spectrum of coronary artery anomalies. Hemodynamically significant anomalies include atresia, origin from the pulmonary artery, interarterial course, and congenital fistula. Non-hemodynamically significant anomalies include duplication; high origin; a prepulmonic, transseptal, or retroaortic course; shepherd's crook right coronary artery; and systemic termination. In general, coronary arteries with an interarterial course are associated with an increased risk of sudden cardiac death. Coronary artery anomalies that result in shunting, including congenital fistula and origin from the pulmonary artery, are also commonly symptomatic and may cause steal of blood from the myocardium. Radiologists should be familiar with each specific variant and its specific constellation of potential implications.

Coronary artery anomalies overview: The normal and the abnormal

“…The artery that supplies the PDA and a posterolateral branch determines the coronary dominance, so there can be three situations: Right-dominance (approximately 70% of the cases) (supply from the RCA), left-dominance (10%) (supply from the LCX), and codominance (20%), the situation in which PDA and posterolateral branches arise from both right and left systems [14] .…”

“…These branches arise in most of the cases from the distal RCA, as right dominance is the most common [14] .…”

“…Cross clamping of the aorta below a high-origin coronary artery may result in unsuccessful induction of cardioplegia. Moreover, the higher the position of a coronary ostium, the higher the risk of coronary hypoperfusion as the sinuses of Valsalva facilitate maximal coronary diastolic perfusion [13,14,23,24] ( Figure 4). …”

“…The prevalence of this variant is estimated of approximately 5%. The shepherd's crook is not clinically significant, but its presence may complicate percutaneous interventions in the RCA [14] ( Figure 5). …”

“…In nearly 15% of patients with CAAs, myocardial ischemia can develop in the absence of B A Figure 5 Shepherd's crook right coronary artery. A: From [14] ; B: Schematic representation.…”